ISSN : 1301-5680
e-ISSN : 2149-8156
Turkish Journal of Thoracic and Cardiovascular Surgery     
The analgesic and hemodynamic effects of dexmedetomidine and remifentanil during chest tube removal
Funda Gümüş1, Sıtkı Nadir Şinikoğlu1, Kerem Erkalp1, Nalan Şanlı1, Berk Özkaynak2, Adil Polat2, Ayşin Alagöl1
1Department of Anesthesiology and Reanimation, Bağcılar Training and Research Hospital, İstanbul, Turkey
2Department of Cardiovascular Surgery, Bağcılar Training and Research Hospital, İstanbul, Turkey
DOI : 10.5606/tgkdc.dergisi.2013.7641
Background: This study aims to investigate the effects of remifentanil and dexmedetomidine in alleviating pain during chest tube removal and these effects were compared in terms of sedation levels, pulmonary and hemodynamic responses.

Methods: The study was designed as a prospective, randomized, double-blinded study. Between February 2011 and July 2011, 41 consecutive patients (31 males, 10 females; mean age 55.7±10.3 years; range 27 to 77 years) who underwent coronary artery bypass graft (CABG) surgery were enrolled. All chest tubes were removed in postoperative 48th hour. The patients were randomized into two groups as dexmedetomidine (0.5 mg/kg) group (group D) and remifentanil (0.5 mg/kg) group (group R). The pain and sedation levels were assessed by numerical rating scale (NRS) and Ramsay scores. Blood pressures [systolic (SAP), diastolic (DAP) and mean (MAP) pressures], peripheral oxygen saturation (SpO2), respiratory rate (RR) and heart rate (HR) were recorded before and after the agent perfusion and every two minutes after the tube was removed.

Results: The demographic characteristics of the patients in both groups were similar. The pain scores were lower during the measurements which were recorded at six and 10 minutes after chest tube removal in group D. The Ramsay scores were found to be statistically different at all measurements following perfusion, compared to the baseline measurements (p<0.05). Systolic arterial blood pressure, MAP and HR were significantly lower in group D and the difference was more pronounced statistically with repeated measurements.

Conclusion: Dexmedetomidine provides a comparable hemodynamic control along with better sedation and analgesia during and after chest tube removal than remifentanil. These effects can be provided safely without having cardiac or respiratory depression in post-cardiac surgery intensive care patients.

Keywords : Chest tube removal; dexmedetomidine; intensive care unit
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